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[Joesmum]

This may need a knowledgable individual to solve this mystery.

I take 3 pumps of Estrogel daily. Divided into 2 doses. I always avoid taking my morning Estrogel before blood tests.

When my endo dose my Estrodial (e2)blood tests at the hospital they usual read about 350 pmols/l.

If my local GP surgery does the Estrodial (e2) blood test the results are much higher at around  700
to 800 pmols.

Also my local private surgery has tested my Estrodial levels and the results were in the 800's.

My Endo is very happy with my levels around 350 pmol so could someone please explain to me why I get consistently higher readings from the other sources?

I just don't know which blood levels to believe. I'm happy with them at 350 pmols but what if the higher blood results are the accurate readings?

[Joesmum]

Sorry to post again but does anyone have any thoughts?

[Hurdity]

If the bloods are taken at exactly the same time of day and before you apply the gel that day, and the same place on your body in realtion to where you apply the gel, if the results are from different labs then that could explain the difference as they all have their own methods and ref ranges. Your results should come with the particular lab ref range anyway - although with estradiol it is so variable at different points in the cycle and with different women then it might not mean much.

Also why worry about the actual results? - I mean how do you feel and what are your bleeds like if you have them - that's more important. Is there anything about your HRT that is worrying you symptoms wise? If not then just  enjoy life and forget about levels! I'm not sure why the docs are insisting on doing them especially the GP - it isn't necessary unless there is something of particular medical concern or symptoms are worrying you and you can't tell if you are absorbing it or not.

Not sure what the endo is? is this endocrinologist?  It's normal for the GP or the menopause clinic ( nurse or gynae) that does the blood tests and monitors HRT - but maybe you have another condition eg thyroid and the endocrinologist is looking at everything? If so - lucky you because I'm not sure this happens that much - although I haven't any experience of how menopause/thyroid etc conditions are  monitored together on NHS (or maybe privately?).

That's a bit of a ramble but just to say I wouldn't worry if you're feeling fine!

Hurdity x

[Joesmum]

Hurdity, thank you so much for your reply. I was hoping for your wise feedback.
I should have explained.....
I had a hysterectomy and oopherectomy so I'm on estrogen replacement only but I'm also hypopituitary so am monitored by an endocrinologist.
Bloods are usually Estrodial, thyroid, cortisol....

I do worry because my Gp says estrogen levels of 800 pmols is ludicrously high. But when I explain that they're only 350 pmols at the hospital he doesn't understand it.......and neither do I.

I just don't want my levels mucked about with any longer because it impacts on the other hormones I take which makes it an exceptionally difficult condition to treat.

Im searching for answers myself in a hope that I can present them to the Doctors so that they'll stop fussing and scaremongering about blood levels and I can finally stick to a specific dosage of Estrogel instead of being told to reduce or raise my dosage according to which laboratory  has done my blood test.

I hope that explains things more clearly.

[Hurdity]

Not very wise - I'm as much in the dark as you are really!

As I said, to me, the most likely explanation is the different methods they use at the different labs to calculate serum estradiol levels - if the results consistently differ to a similar degree (ie not just the once). There is an article about estradiol measurement here: https://www.news-medical.net/health/Estradiol-Measurement.aspx though not sure how directly relevant it is. Another one discussing lack of standardisation here:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5699465/

The only way you can tell this for sure (difference due to labs) is for you to have the blood taken and samples of the same blood sent to the different labs that have given the most variation in the result. Wide differences as previously found would prove it was the lab. However which one would be more accurate – the higher or the lower is anybody's guess!

The main thing is if your endocrinologist is happy and you are feeling well - then this is all that matters surely - and your GP should accept this? In any case different rules should apply for women in surgical menopause who lack even residual ovarian production of oestrogen or their precursors.

I hope you manage to resolve this and continue to feel well!

Hurdity x

[racjen]

Also your GP is wrong in maintaining that levels of 800 pmol+ are ludicrously high - some experts believe that women who suffer particularly from menopausal depression need levels of at least this high to feel OK (Dr. John Studd and Dr. Sarah Gray to name but two).

[Joesmum]

Hurdity and Racjen,
Thank you so much for your replies.

Hurdity - the difference in blood levels from different labs does seem to be consistent as repeated blood tests have shown the same results.
As you say......which is the accurate measure.....the high or low figure?
My endo is happy with my 350 pmol which is the usual hospital result so I think I will just continue with his care and guidance. He's the one who has to do the juggling act with the other hormones.
 I achieve this level on 3 pumps of Estrogel. I have no breast tenderness, no symptoms of over medication and am where my Endo likes the levels to be. I still get tired but that could also be thyroid,.....cortisol.......it's complicated!

Most importantly you've made me feel far less worried and concerned and for that I'm very grateful. Thank you so much.

[Hurdity]

xx